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Clinical Pelvimetry

This document outlines the step-by-step procedure for performing a clinical pelvimetry exam. Key measurements taken include the diameter conjugate (DC), sacral curvature, ischial spines, bispinous diameter, pelvic sidewalls, sacrosciatic notch, bituberous diameter, retropubic angle, and pubic arch. Abnormal findings indicative of a contracted pelvis are also described.

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Valerie Gonzaga-Carandang
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4K views3 pages

Clinical Pelvimetry

This document outlines the step-by-step procedure for performing a clinical pelvimetry exam. Key measurements taken include the diameter conjugate (DC), sacral curvature, ischial spines, bispinous diameter, pelvic sidewalls, sacrosciatic notch, bituberous diameter, retropubic angle, and pubic arch. Abnormal findings indicative of a contracted pelvis are also described.

Uploaded by

Valerie Gonzaga-Carandang
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CLINICAL PELVIMETRY

Step by step procedure

1. Greet the patient, introduce our self to the patient


2. Explain that a pelvic exam/internal exam will be done and describe the
steps in examination
3. Ask the patient to empty the bladder and to wash and rinse the genital area
4. Ask the patient to undress and lie on the examining table in a dorsal
lithotomy position
5. Apply drapes on to the patient
6. Wash hands thoroughly with soap and water
7. With an examining sterile gloves with lubricated KY jelly, separate the labia
with 2 fingers and insert to the vagina the index and middle finger.

*** inspect the external genitalia for any lesions, masses, or discharge
*** do a speculum exam, and note any inflammation and lesions on the vaginal
wall, and note any findings on the cervix, its color, for presence of lesions, and
discharge
***Do an internal exam

Evaluate the pelvic inlet

With a sterile gloves, lubricate the index and middle finger, insert into the vagina,
drop down the wrist, until it reaches the sacral promontory. This measures the
DC, which is from the lower margin of the symphysis pubis to the midpoint of
sacral promontory, normal value is >11.5cm, this is the AP diameter in the pelvis
that can be measured clinically. Adequate pelvis, sacral promontory cannot be
easily reached while contracted pelvic inlet, sacral promontory can easily be
reached.

Evaluate the midpelvis

Sacral curvature: Pronate the fingers 90 degrees and palpate the curvature of
sacrum moving the fingers inferiorly, anterior surface of the sacrum is described
as hollow, flat, shallow
Ischial spine: reference point for midpelvis, Asses the ischial spines, and slightly
remove the fingers from the vagina, and moving it to the 4 and 8 o cock in the
midpelvis, described as prominent or blunt

Generalized Assessment of the bispinous diameter is made; helpful in assessing


the transverse plane of the pelvis is normal, narrow, wide. normal is about 10cm.

Assess the pelvic sidewalls: using the index and middle finger hold the ischial
spine while palpating the ipsilateral ischial tuberosity. If the tuberosity is
lateral to the spine: divergent pelvic side wall
in line with the spine: parallels sidewalls
medial to the spine: convergent side wall

**Sacrosciatic notch: adequate if more than 2 finger breadths

Evaluate the pevic outlet


Reference is the ischial tuberosity.

1)Placed a closed fist on the perineum, if the ischial tuberosity is felt outside the
4 knuckles, it in considred a wide bituberous distance. If narrow bituberous
diameter, the ichial tuberosities are felt inside the the 4 knuckles

2) Estimate the retropubic angle; insert internal examining fingers behind the
pubic bone and palpate for the posterior surface of the pubic bone.
Describes as wide, narrow, round, or angulated, in degrees greater than or equal
90 degrees

3) Estimate the pubic arch


Wide – if more than >100 degrees
Normal – if between 90-100 degrees
Narrow – if less than 100 degrees

Contracted Pelvis
DC is <11.5cm; SP is easily reached

Sacrum has shallow concavity


Prominent ischial spines
Bispinous diameter is <10cm
Convergent sidewalls

Bituberous diameter < 8cm


Pubic arch is < 90 degrees

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